Abstract：
BACKGROUND: Policymakers and researchers often suggest that nurses may play a crucial role in addressing the evolving needs of patients with complex conditions, by taking on advanced roles and providing nursing consultations. Nursing consultations vary widely across settings and countries, and their activities range from complementing to substituting traditional physician-led consultations or usual care.
OBJECTIVE: This study was aimed at describing the effects of nursing consultations with patients with complex conditions in any setting on patient outcomes (quality of life, physical status, psychosocial health, health behaviour, medication adherence, mortality, anthropometric and physiological outcomes, and patient satisfaction) and organisational outcomes (health resource use and costs).
METHODS: Umbrella review.
METHODS: We followed the Joanna Briggs Institute method for umbrella reviews. We searched PubMed, Embase, Cochrane Database of Systematic Reviews and CINAHL to identify relevant articles published in English, Dutch, French, Spanish or German between January 2013 and February 2023. We included systematic literature reviews, with or without meta-analyses, that included randomised controlled trials conducted in high-income countries. Reviews were eligible if they pertained to consultations led by specialised nurses or advanced nurse practitioners. Article selection, data extraction and quality appraisal were performed independently by at least two reviewers.
RESULTS: We included 50 systematic reviews based on 473 unique trials. For all patient outcomes, nursing consultations achieved effects at least equivalent to those of physician-led consultations or usual care (i.e., non-inferiority). For quality of life, health behaviour, medication adherence, mortality and patient satisfaction, more than half the meta-analyses found statistically significant effects in favour of nursing consultations (i.e., superiority). Cost results must be interpreted with caution, because very few and heterogeneous cost-related data were extracted, and the methodological quality of the cost analyses was questionable. Narrative syntheses confirmed the overall conclusions of the meta-analyses.
CONCLUSIONS: The effects of nursing consultations on patients with complex health conditions across healthcare settings appear to be at least similar to physician-led consultations or usual care. Nursing consultations appear to be more effective than physician-led consultations or usual care in terms of quality of life, health behaviour, mortality, patient satisfaction and medication adherence. Further analysis of the primary data is necessary to determine the patient populations and settings in which nursing consultations are most effective. Moderate study quality, diversity amongst and within systematic reviews, and quality of reporting hamper the strength of the findings.
OBJECTIVE: This study was aimed at describing the effects of nursing consultations with patients with complex conditions in any setting on patient outcomes (quality of life, physical status, psychosocial health, health behaviour, medication adherence, mortality, anthropometric and physiological outcomes, and patient satisfaction) and organisational outcomes (health resource use and costs).
METHODS: Umbrella review.
METHODS: We followed the Joanna Briggs Institute method for umbrella reviews. We searched PubMed, Embase, Cochrane Database of Systematic Reviews and CINAHL to identify relevant articles published in English, Dutch, French, Spanish or German between January 2013 and February 2023. We included systematic literature reviews, with or without meta-analyses, that included randomised controlled trials conducted in high-income countries. Reviews were eligible if they pertained to consultations led by specialised nurses or advanced nurse practitioners. Article selection, data extraction and quality appraisal were performed independently by at least two reviewers.
RESULTS: We included 50 systematic reviews based on 473 unique trials. For all patient outcomes, nursing consultations achieved effects at least equivalent to those of physician-led consultations or usual care (i.e., non-inferiority). For quality of life, health behaviour, medication adherence, mortality and patient satisfaction, more than half the meta-analyses found statistically significant effects in favour of nursing consultations (i.e., superiority). Cost results must be interpreted with caution, because very few and heterogeneous cost-related data were extracted, and the methodological quality of the cost analyses was questionable. Narrative syntheses confirmed the overall conclusions of the meta-analyses.
CONCLUSIONS: The effects of nursing consultations on patients with complex health conditions across healthcare settings appear to be at least similar to physician-led consultations or usual care. Nursing consultations appear to be more effective than physician-led consultations or usual care in terms of quality of life, health behaviour, mortality, patient satisfaction and medication adherence. Further analysis of the primary data is necessary to determine the patient populations and settings in which nursing consultations are most effective. Moderate study quality, diversity amongst and within systematic reviews, and quality of reporting hamper the strength of the findings.
摘要：
背景：政策制定者和研究人员经常建议，护士可能在解决复杂疾病患者不断变化的需求方面发挥关键作用，通过担任高级角色并提供护理咨询。护理咨询在不同的环境和国家之间差异很大，他们的活动范围从补充到替代传统的由医生主导的咨询或常规护理。
目的：本研究旨在描述在任何情况下对复杂患者进行护理咨询对患者预后的影响（生活质量，身体状况,社会心理健康,健康行为,药物依从性,死亡率,人体测量和生理结果，和患者满意度)和组织结果(卫生资源使用和成本)。
方法：雨伞综述。
方法：我们采用了JoannaBriggsInstitute的伞式评价方法。我们搜索了PubMed,Embase,Cochrane系统评论数据库和CINAHL，以确定以英语发表的相关文章，荷兰人,法语,2013年1月至2023年2月期间的西班牙语或德语。我们包括系统的文献综述，有或没有荟萃分析，其中包括在高收入国家进行的随机对照试验.如果评论涉及由专业护士或高级护士从业人员领导的咨询，则符合资格。文章选择,数据提取和质量评估由至少两名评审员独立进行.
结果：我们纳入了基于473项独特试验的50项系统综述。对于所有患者结果，护理咨询取得的效果至少相当于医生主导的咨询或常规护理的效果(即，非自卑)。为了生活质量，健康行为,药物依从性,死亡率和患者满意度，超过一半的荟萃分析发现，有利于护理咨询的统计学显著影响(即，优势)。必须谨慎解释成本结果，因为提取了很少和异构的成本相关数据，成本分析的方法学质量值得怀疑。叙事综合证实了荟萃分析的总体结论。
结论：护理咨询对医疗环境中复杂健康状况患者的影响似乎至少与医生主导的咨询或常规护理相似。在生活质量方面,护理咨询似乎比医生主导的咨询或常规护理更有效,健康行为,死亡率,患者满意度和药物依从性。有必要对原始数据进行进一步分析，以确定护理咨询最有效的患者人群和设置。中等学习质量，系统评价之间和内部的多样性，报告的质量阻碍了调查结果的强度。
目的：本研究旨在描述在任何情况下对复杂患者进行护理咨询对患者预后的影响（生活质量，身体状况,社会心理健康,健康行为,药物依从性,死亡率,人体测量和生理结果，和患者满意度)和组织结果(卫生资源使用和成本)。
方法：雨伞综述。
方法：我们采用了JoannaBriggsInstitute的伞式评价方法。我们搜索了PubMed,Embase,Cochrane系统评论数据库和CINAHL，以确定以英语发表的相关文章，荷兰人,法语,2013年1月至2023年2月期间的西班牙语或德语。我们包括系统的文献综述，有或没有荟萃分析，其中包括在高收入国家进行的随机对照试验.如果评论涉及由专业护士或高级护士从业人员领导的咨询，则符合资格。文章选择,数据提取和质量评估由至少两名评审员独立进行.
结果：我们纳入了基于473项独特试验的50项系统综述。对于所有患者结果，护理咨询取得的效果至少相当于医生主导的咨询或常规护理的效果(即，非自卑)。为了生活质量，健康行为,药物依从性,死亡率和患者满意度，超过一半的荟萃分析发现，有利于护理咨询的统计学显著影响(即，优势)。必须谨慎解释成本结果，因为提取了很少和异构的成本相关数据，成本分析的方法学质量值得怀疑。叙事综合证实了荟萃分析的总体结论。
结论：护理咨询对医疗环境中复杂健康状况患者的影响似乎至少与医生主导的咨询或常规护理相似。在生活质量方面,护理咨询似乎比医生主导的咨询或常规护理更有效,健康行为,死亡率,患者满意度和药物依从性。有必要对原始数据进行进一步分析，以确定护理咨询最有效的患者人群和设置。中等学习质量，系统评价之间和内部的多样性，报告的质量阻碍了调查结果的强度。
